(Versi Kantor)

KOP SURAT DARI DINKES / DOKTER YANG BERSANGKUTAN

Mahakam Ulu, 5th April 2023

SAUDI VISA BIO REQUIREMENT

LETTER OF STATEMENT

Salaam,

I am writing to you in relation to the above matter. The names that are listed below:

No. NAME PASSPORT NUMBER NATIONALITY

are unable to do the biomedic process as a requirement of making the Saudi Visa Bio
because the fingerprints could not be recorded. Those people work as craftsmen and that
affects the condition of their fingers.

If the Ministry needs any further information, please contact us directly.

Regards,
Head Office,

(Nama kepala kantor)

NIP.
(Versi Pribadi)

Makaham Ulu, 5TH April 2023

LETTER OF STATEMENT

Salaam,

I, ------------------------------------------------------(nama) the prospective pilgrim for Hajj 2023 with

passport number ….. (nomor paspor), am unable to do the recording session of my
fingerprints as part of the visa bio requirement due to the condition of my fingers. As a
craftsman myself, my fingerprints are not in the best condition so that they could not be
seen on the Saudi Visa Bio app.
I am willing to do additional processes monitored by the health authority if that is needed.
This statement is made truthfully and to be used accordingly.

Acknowledged,
Yours sincerely, Head office of Kantor Kementerian Agama
(atau yang mewakili),

Tanda tangan Tanda tangan

(nama lengkap) (nama lengkap)